Hot Topics:

Plan to limit public aid for fertility treatment causing stir

By Kumiko Nakajima and Akihiko Kano, Yomiuri Shimbun

Posted:
04/23/2013 07:34:09 AM EDT

Many people have to quit their job due to difficulties in working and receiving the treatment at the same time, says Akiko Matsumoto, president of Fine, a Tokyo-based nonprofit supporting people with fertility problems. (Staff)

The government's recent decision to discuss limiting public aid for fertility treatment to women ages 39 or younger, as well as how often aid can be received is causing concern among people undergoing such treatment.

The Health, Labor and Welfare Ministry decided earlier this month to consider establishing the age limit based on a report compiled by a ministry study group that concluded fertility treatment is riskier and less effective for women 40 and older.

The ministry is believed to have made the decision in the aim of providing effective fertility treatment to women who are relatively young and more fertile. But concerns have been raised among women 40 and older who are already receiving treatment.

The study group headed by Keio University Prof. Yasunori Yoshimura said in the March report that public aid for fertility treatments should be limited to women ages 39 or younger if an age limit is introduced.

The aid began in 2004 to provide financial support for infertile couples, as treatments are not covered by public health insurance and cost about 300,000 yen to 400,000 yen per treatment, including egg collection. Aid is provided for up to 150,000 yen per treatment and shared equally by the national and local governments.

A couple's annual income must be 7.3 million yen or less to receive the grant, but there is no age limit. In fiscal 2011, aid was provided for 113,000 treatments, a marked increase from 18,000 in fiscal 2004.

Advertisement

According to data on nationwide fertility treatment, or external fertilization, from 2007 to 2010, the rate of pregnancy was about 20 percent among women ages 32 or younger, but the success rate starts dropping sharply from age 36, falling to 8 percent among women aged 40 and 1 percent among those aged 44.

Additionally, the chances of a miscarriage rise with age.

However, 36 percent of women receiving the treatment were 40 or older, according to the 2010 data.

Older women are more likely to develop pregnancy-induced hypertension or have chromosome abnormalities in the fetus.

The study group's report and the subsequent government move are causing concern among people receiving the treatment.

A 40-year-old part-time worker in Chiba Prefecture said she is uncomfortable since it invites all-out differentiation between women aged 39 or younger and those aged 40 or older. "Things can be very different even among women of the same age," she said.

The woman began receiving fertility treatment at 37, the second year after her marriage. She started external fertilization last year.

It costs her up to 700,000 yen each time she receives the treatment, which includes placing a fertilized egg in her uterus. Her monthly part-time pay is 30,000 yen.

She said she is using money she saved when she was single to get by.

Fine, a Tokyo-based nonprofit supporting people with fertility problems, said half the people they surveyed paid more than 1 million yen in total for fertility treatments.

Fine director Akiko Matsumoto said many people have to quit their job due to difficulties in working and receiving the treatment at the same time. This is because the date to collect an egg for external fertilization or to place a fertilized egg in a woman's uterus is decided at the last minute.

External fertilization costs are covered by insurance or publicly subsidized in the United States and some European and Asian countries.

According to the International Society of Reproductive Medicine data in 2010, an age limit is in place in many countries. Such public aid is limited, for example, to women aged 44 or younger in South Korea, 42 or younger in France and 40 or younger in Singapore.

Osamu Ishihara of Saitama Medical University Hospital's obstetrics and gynecology department, who is well versed in foreign fertility treatment systems, said the system has been built on a scientific and cost-benefit basis in other countries.

"It cannot be helped that the Japanese system, on the other hand, is called a welfare handout, although the aid is helping reduce the financial burden of patients," Ishihara said.

Reviewing the number of times aid can be received is another issue.

Currently, the aid is offered up to three times in the first fiscal year and up to two times each fiscal year thereafter. Aid is provided a maximum of 10 times over five years.

Through analysis of National Center for Child Health and Development data, the study group found 78 percent of treatments took place during the first two years, and 92 percent of women who gave birth did so within six treatments.

The study group proposed providing aid six times over two years, while placing no limit on the number of treatments per year, which is believed to allow people to use the aid according to their circumstances.